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Abstract

Laboratory testing is necessary when it contributes to the overall clinical management of the patient. Redundant testing, however, is often unnecessary and expensive and contributes to overall reductions in healthcare system efficiency. The purpose of this study is two-fold. First, to evaluate the frequency of ordering duplicate laboratory tests in hospitalized patients and the costs associated with this practice. Second, it was designed to determine if the use of a computerized alert or prompt will reduce the total number of unnecessarily duplicated Acute Hepatitis Profile (AHP) laboratory tests. This two-phase study took place in an inpatient facility that was part of a large tertiary care hospital system in Florida. A retrospective descriptive design was used during Phase 1 was to evaluate six laboratory tests and the frequency of ordering duplicate laboratory tests in hospitalized patients and to determine the associated costs of this practice for a 12-month time period in 2010. A test was considered a duplicate or an unnecessarily repeated test if it followed a previous test of the same type during the patient’s length of stay in the hospital and one in which any change in their values likely would not be clinically significant. A quasi-experimental pre- and post-test design was used during phase 2 was to determine the proportion of duplication of the AHP test before and after the implementation of a computerized alert intervention implemented as part of a system quality improvement process on January 5th, 2011. Data were compared for two 3-month time periods, pre- and post-alert implementation. The AHP test was considered redundant if it followed a previous test of the same type within 15 days of the initial test being final and present in the medical record. In phase 1, including each of the six tests examined, there were a total amount of 53, 351 test ordered, with 10, 375 (19.4%) of these cancelled. Out of the total amount of result final tests iv (n = 42,976), including each of the six tests examined, 4.6-8.7% were redundant. Results of the proportion of duplication of the six selected tests are as follows: AHP 196/2514 (7.8%), Antinuclear Antibody (ANA) 120/2594 (4.6%), B12/Folate level 396/5874 (6.7%), Thyroid Stimulating Hormone (TSH) 1893/21595 (8.7%), Ferritin 384/5171 (7.4%), and Iron/Total iron binding capacity (TIBC) 316/5155 (6.1%). The overall associated yearly cost of redundant testing of these six selected tests was an estimated $419, 218. The largest proportion of redundant tests was the Thyroid Stimulating Hormone level, costing a yearly estimated $300, 987. In Phase 2, prior to introduction of the alert, 674 AHP tests were performed. Of these, 53 (7.9%) were redundant. During the intervention period, 692 AHP tests were performed, of these 18 (2.6%) were redundant. The implementation of the computerized alert was shown to significantly reduce the proportion of AHP tests (Chi-Square: χ2 = df 1, p ≤ 0.001). The differences in the associated costs of duplicated AHP were $5238 dollars in 2010 as compared to $1746 in 2011 post-alert and these differences were significant (Mann Whitney U, Z = -4.04, p ≤ 0.001). Although the proportions of unnecessarily repeated diagnostic tests that were observed during Phase 1 of this study were small, the associated costs could adversely affect hospital revenue and overall healthcare efficiency. The implementation of the AHP computerized alert demonstrated a drop in the proportion of redundant AHP tests and subsequent associated cost savings. It is necessary to perform further research to evaluate computerized alerts on other tests with evidence-based test-specific time intervals, and to determine if such reductions postimplementation of AHP alerts are sustained over time.

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